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Cancer Causes & Control

, Volume 26, Issue 7, pp 1019–1026 | Cite as

Survival among Black and White patients with renal cell carcinoma in an equal-access health care system

  • Jie Lin
  • Shelia H. Zahm
  • Craig D. Shriver
  • Mark Purdue
  • Katherine A. McGlynn
  • Kangmin Zhu
Original paper

Abstract

Purpose

Unequal access to health care may be a reason for shorter survival among Black patients with renal cell carcinoma (RCC) than among their White counterparts. No studies have investigated survival disparity among RCC patients in an equal-access health care delivery system. This study aimed to examine racial differences in survival among clear cell RCC patients in the Department of Defense’s (DoD) Military Health System (MHS), which provides equal access to care to all persons.

Methods

The study used the DoD’s Automated Central Tumor Registry to identify 2056 White patients and 370 Black patients diagnosed with clear cell RCC between 1988 and 2004. The subjects were followed through 2007 with a median follow-up time of 4.8 years. Kaplan–Meier survival curves were compared and a Cox model was used to estimate the hazard ratios (HRs) associated with survival by race.

Results

During follow-up, 1,027 White and 158 Black patients died. The Kaplan–Meier curves showed that Black patients had more favorable overall survival than did White patients (log rank p = 0.031). After adjustment for demographic, tumor, and treatment variables, the Cox model showed no statistically significant racial difference overall (adjusted HR 1.07, 95 % CI 0.90–1.28) or stratified by age, sex or tumor stage. However, among patients who did not undergo surgery, Black patients had poorer survival than White patients.

Conclusions

The lack of racial difference in survival among RCC patients in the MHS may be related to equal access to health care. Improved access could reduce the survival disparity among RCC patients in the general population.

Keywords

Renal cell carcinoma Racial disparity Survival Equal access Hazard ratio 

Notes

Acknowledgments

This project was supported by John P. Murtha Cancer Center, Walter Reed National Military Medical Center via the Uniformed Services University of the Health Sciences under the auspices of the Henry M. Jackson Foundation for the Advancement of Military Medicine, and by the intramural research program of the National Cancer Institute. The authors thank the Joint Pathology Center (formerly Armed Forces Institute of Pathology) for providing the data. We thank Mr. Derek Brown for his input in statistical analysis.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Jie Lin
    • 1
  • Shelia H. Zahm
    • 2
  • Craig D. Shriver
    • 1
    • 3
    • 4
  • Mark Purdue
    • 2
  • Katherine A. McGlynn
    • 2
  • Kangmin Zhu
    • 1
    • 4
  1. 1.Division of Military Epidemiology and Population Sciences, John P. Murtha Cancer CenterWalter Reed National Military Medical CenterRockvilleUSA
  2. 2.Division of Cancer Epidemiology and GeneticsNational Cancer InstituteBethesdaUSA
  3. 3.General Surgery ServiceWalter Reed National Military Medical CenterBethesdaUSA
  4. 4.Uniformed Services UniversityBethesdaUSA

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